Vikram Khanna

In Search of a New Screening Test for Osteoarthritis - Is Urinary Nitratethe Answer?

Introduction: Even as early as 1916 it was suggested that the nitric oxide is synthetized in the mammals. This nitric oxide, synthetized in the body, was responsible for vasodilation by the endothelium derived relaxing factors and also by the stimulation of the guanylyl cyclase. Inflammatory conditions increase the production of nitrates and nitrites which is seen in the response to endotoxin and is accompanied with nitrosamine formation. Nitric oxide, hence, has been thought to be the physiological messenger and is increases in the pathological processes. This present study was conducted to find the association between the urinary secretion of nitrates and the osteoarthritis. Design: A total of 200 patients coming to the hospital out of 100 were patients with osteoarthritis of the knee joint and 100 were randomly selected. All the patients were screened for the causes of secondary osteoarthritis. Urine sample from all the patients was obtained along with X-ray of bilateral knees was taken to assess the grade of osteoarthritis. The osteoarthritic patients were assigned Group A and the randomly chosen patients were assigned the Group B. Both groups were compared and the results were evaluated. Results: In group A there were 5 cases with urinary nitrate positive as compared to 4 cases with positive urinary nitrate in group B, which was not statistically significant (p > 0.05). Conclusion: The current study clearly shows that there is no association between the urinary nitrate levels and OA.

Bisphosphonates-induced Atypical Subtrochanteric Fracture Femur: A Case Report

A 71-year-old female came to our institute with a subtrochanteric left femur fracture following a fall from her bed. It was a low-energy trauma, and the X-rays were suggestive of an atypical fracture following bisphosphonate therapy for five years. The fracture was fixed with intramedullary nailing following which she was started on partial weight-bearing walking after three weeks. The fracture went on to a nonunion; after one year, the fracture site was opened and bone grafting with bone marrow injection, along with augmented plating, was done. The fracture showed signs of union three months postoperatively. Fractures associated with bisphosphonate therapy may be associated with delayed union or nonunion and should be explained to the patient.

Comparative prospective study between medial and lateral distal tibial locking compression plates for distal third tibial fractures

Purpose Tibial fracture is the most common long bone fracture. Distal third tibial fractures are challenging though open reduction and plating can result in anatomical reduction and rigid fixation. This paper aimed to evaluate and compare the results of medial and lateral locking compression plates for distal third tibial fractures. Methods This prospective clinical study involved 36 patients with distal tibial fractures admitted in Department of Orthopaedics, Sawai Mansingh Medical College & Affiliated Hospital, Jaipur, India, from June 2011 to May 2012, including 29 closed fractures and 7 open fractures at the mean age of 38.9 years. Thirty-six patients were divided equally into two groups based on treatment method, including medial plating group (18 patients) and lateral plating group (18 patients). They were followed up for at least 5 months after discharge. The functional outcomes were evaluated using Tenny and Wiss clinical assessment criteria. Results Malunion was found in 3 cases of medial plating group and in 1 case of lateral plating group. In the medial plating group, there were 5 cases of superficial infections, 1 deep infection, 1 nonunion and 3 wound dehiscence. In the lateral plating group, there was 1 case of superficial infections, 1 deep infection and 1 nonunion. In the lateral plating group, 4 patients reported feeling the plates and screws but none of them asked to remove the hardware. In the medial plating group, 9 patients reported symptomatic hardware problems and 7 asked to remove the hardware. The number of cases graded as excellent/good/fair was 1/8/7 in the medial plating group and 3/7/7 in the lateral plating group respectively. In the medial plating group, the final range of motion was 17.2° in ankle dorsiflexion and 30.7° in ankle plantar flexion. In the lateral plating group, the final range of motion was 19° in ankle dorsiflexion and 34.2° in ankle plantar flexion. Conclusion Lateral plating of distal tibia is safe and feasible, which can provide biological fixation and prevent the soft tissue complications associated with medial plating.

A neglected case of Klippel Trenaunay Weber syndrome

This congenital vascular disorder is described by a “triad” of symptoms affecting one or more limbs. The “triad” constitutes varicose veins, cutaneous hemangioma, with bone and soft tissue hypertrophy. The cutaneous hemangioma presents as a substantial port-wine stain or nevus. Varicose veins are often very numerous. Bone and soft tissue hypertrophy is variable in presentation and the affected limb may be either larger or smaller than the normal limb. This disorder is generally reported in childhood or adolescent age groups. We herein present a neglected case of Klippel Trenaunay Syndrome with all the classical clinical and radiological findings. A 30-year-old man reported with the classical triad. On clinical examination substantial port wine stain was seen and radiographs showed multiple bony outgrowths whereas MRI showed multiple varicosities displaying heterogeneous hyper intense signals on T2 Weighted Images and T1 hypo intensity with hypertrophy of soft tissue in left lower limb.